Citation Nr: 0028213
Decision Date: 10/25/00 Archive Date: 11/01/00
DOCKET NO. 97-17 545 ) DATE
)
)
On appeal from the
Department of Veterans Affairs (VA) Regional Office (RO) in
Columbia, South Carolina
THE ISSUE
Entitlement to a rating greater than 10 percent for post-
traumatic stress disorder (PTSD).
REPRESENTATION
Appellant represented by: The American Legion
ATTORNEY FOR THE BOARD
M. Cooper, Associate Counsel
INTRODUCTION
The veteran served on active duty from July 1966 to August
1970.
This matter comes before the Board of Veterans' Appeals
(Board) on appeal from a June 1998 RO decision which granted
service connection and a 10 percent rating for PTSD; he
appeals for a higher rating. The Board remanded the case in
May 1999 for further development, and the case was returned
to the Board in September 2000.
FINDINGS OF FACT
The veteran's PTSD does not result in more than occupational
and social impairment due to mild or transient symptoms which
decrease work efficiency and ability to perform occupational
tasks only during periods of significant stress; and PTSD
symptoms are controlled with medication.
CONCLUSION OF LAW
The criteria for an evaluation in excess of 10 percent for
PTSD have not been met. 38 U.S.C.A. § 1155 (West 1991 &
Supp. 2000); 38 C.F.R. § 4.130 Code 9411 (1999).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
I. Factual Background
The veteran served on active duty in the Army from July 1966
to August 1970, including a tour of duty in Vietnam. His
decorations indicate combat service. His service medical
records are negative for a psychiatric disorder.
A March 1995 private hospital record reflects that the
veteran was admitted due to manic symptoms that included some
psychotic features prior to admission. He reported he
recently was taking a variety of medications for physical
ailments, and this was followed by an increase in psychiatric
symptoms. The discharge diagnoses were probable organic
affective disorder, manic, in partial remission, and consider
bipolar affective disorder, manic, in partial remission.
On VA examination in May 1995, the veteran reported he had a
bachelor degree in criminal justice and was presently working
as a U.S. marshal. He was currently married (his third wife)
and they had a young child. It was noted the veteran was
active in church, attended veterans meetings, and had a hobby
of model airplanes. The veteran reported that his
psychiatric history was completely negative until March 1995.
He related that he suddenly awoke at night with severe
dizziness, nausea, vomiting, and confusion. He said he
experienced vivid flashbacks about Vietnam and punched a hole
through the wall with his fist. He indicated that he was
hospitalized for 15 days and had a complete neurological
evaluation; however, he was told that nothing was found. He
was subsequently referred to an outpatient veterans group and
was told that he might have PTSD. The veteran said that he
was involved in search and destroy missions and saw a great
deal of combat during service in Vietnam. It was noted that
his mood showed no evidence of anxiety or depression. The
examiner indicated that the veteran did not meet the criteria
for a diagnosis of PTSD.
A May 1995 VA psychological evaluation showed that the
veteran was somewhat depressed and overwhelmed by the stress
of his job as a federal marshal. The diagnosis was
dysthymia.
Records from the mid 1990s note the veteran was being treated
for a vocal cord disorder (spasmodic dysphonia), and during
such treatment in August 1995 he mentioned he worked as a
deputy U.S. marshal and hoped to complete the next 10 months
of service in order to qualify for retirement.
In a March 1997 statement the veteran indicated that he was
an infantry platoon leader in Vietnam. He said that he had
PTSD and reported that he had nightmares about his combat
experiences in Vietnam.
In a statement dated in May 1997, Jeanne C. Morrow, M.D. said
that the veteran met the DSM-IV criteria for a diagnosis of
PTSD. Dr. Morrow stated that the veteran had intrusive
recollections of his Vietnam experience, hypervigilance,
irritability, sleep difficulties, and interference with
interpersonal functioning.
During a September 1997 RO hearing on the issue of service
connection for PTSD, the veteran testified regarding his
combat history in Vietnam. He stated that he had sleep
problems, nightmares, and disorientation related to his
service in Vietnam. He said his problems prompted him to put
in for retirement from his federal deputy marshal job. The
veteran's father testified about the veteran's adjustment
problems.
In a September 1997 statement, David Hollingsworth, a Vet
Center team leader, indicated that the veteran participated
in a support group to deal with his combat experiences in
Vietnam beginning in March 1995. It was noted that he
rejoined the group in April 1997. Mr. Hollingsworth related
that the veteran suffered from a variety of symptoms
associated with PTSD, including survivor guilt, intrusive
thoughts and nightmares, numbing feelings, anger, depression,
and isolation at times.
On VA psychiatric examination in June 1998, the veteran
reported that he was getting ready to retire from his U.S.
marshal job because he was unable to do his job the way he
needed to and was taking a lot of sick time. He reported he
was currently under treatment for a vocal cord disorder. He
reported he remained married and had a young child. It was
noted he was active in church, socialized fairly well, and
attended veterans meetings from time to time. He complained
of intrusive thoughts and distressing recollections of
Vietnam, with increasing frequency. He stated that he had
nightmares about a few times per month. He indicated that he
lacked interest in some activities and was unable to function
adequately at home or work due to intrusive thoughts. He
related that he was active in church activities and
socialized fairly well. He denied irritability, angry
outbursts, or difficulty concentrating, but reported
significant exaggerated startle response and some
hypervigilance. He denied depression, or manic or psychotic
symptoms. He was currently taking medication for psychiatric
symptoms. On mental status examination, it was noted that he
related extremely well. He was coherent, logical, and goal
directed. His mood was said to be not too good, and he had a
somewhat restricted affect. He was alert, oriented and his
memory was good. The assessment was mild PTSD. The Global
Assessment of Functioning (GAF) score was 70. The examiner
noted that the veteran's symptoms met the criteria for PTSD;
however, they were very mild in nature. The GAF score
indicated that he had some difficulty in social and
occupational functioning but generally could function fairly
well and had meaningful interpersonal relationships.
In a June 1998 decision, the RO granted service connection
for PTSD, and assigned a 10 percent evaluation for the
condition. The veteran appealed for a higher rating.
In an October 1998 letter, Dr. Morrow stated that the veteran
had been diagnosed with PTSD and he continued to suffer
residual symptoms due to his service in Vietnam. She said
that this had resulted in his retiring from his job five
years before his retirement age due to chronic PTSD symptoms.
In 1999 the veteran was diagnosed as having prostate cancer
and underwent surgery for same. Service connection and a
total rating were subsequently granted for prostate cancer.
In April 2000, the RO received private treatment notes Dr.
Morrow dated March 1995 to February 2000. The medical
records show periodic psychiatric treatment at irregular
intervals (at times there were several months between
visits), and the veteran was prescribed medication for
control of symptoms. The records primarily reflect treatment
for hypomania symptoms, bipolar affective disorder,
depression, and marital conflict; there are only occasional
references to PTSD symptoms. The records mention that in mid
1998 the veteran retired from his job as a federal marshal,
reportedly after completing 30 years of service. At his last
visit in February 2000, he was reported to be doing very
good.
On VA examination in May 2000, the veteran reported that he
attended sessions once every three months with Dr. Morrow,
who prescribed medication for his psychiatric symptoms. He
related that he retired in 1998 from his job with the U.S.
Marshals Service and had not worked since that time. He said
that he had been married three times and was currently
separated from his third wife. He indicated that he was
raising his son, had just bought a fishing boat, and planned
to often take his son fishing over the summer. He reportedly
was active in his church, and saw his friends and had dinner
with them on a weekly basis. The veteran indicated he
enjoyed reading, participated in a bowling league twice a
week, maintained several acres of land, and enjoyed yard work
and taking care of pets. On mental status examination, the
veteran was alert, oriented, and attentive. His mood
appeared euthymic. Speech was normal, eye contact was good,
and he was cooperative. Thoughts were logical and coherent,
and memory was intact. He demonstrated some mild problems
with concentration and had limited insight. The diagnostic
impression was very mild PTSD. His GAF score was 70. The
examiner indicated that the veteran exhibited very mild
symptoms associated with PTSD including slight sleep
disturbance, some flashbacks when helicopters fly over low,
some psychological reactivity, and occasional intrusive
thoughts. It was noted that his social adaptability and
interactions with others did not appear to be impaired. His
PTSD-related ability to maintain employment and perform job
duties was described as not significantly impaired, maybe
slightly impaired. The examiner again said that he estimated
the disability level to be in the very mild range.
In a September 2000 letter, Dr. Morrow again stated that she
had treated the veteran since March 1995. The doctor
indicated that his GAF was 65.
II. Analysis
The veteran's claim for a rating higher than 10 percent for
PTSD is well grounded, meaning plausible. The file shows
that the RO has properly developed the evidence, and there is
no further VA duty to assist the veteran with his claim.
38 U.S.C.A. § 5107 (a).
Disability evaluations are determined by the application of a
schedule of ratings which is based on average impairment of
earning capacity. Separate diagnostic codes identify the
various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4.
A 10 percent rating will be assigned for PTSD when there is
occupational and social impairment due to mild or transient
symptoms, which decrease work efficiency and ability to
perform occupational tasks only during periods of significant
stress; or symptoms controlled by continuous medication.
PTSD will be rated 30 percent when there is occupational and
social impairment with occasional decrease in work efficiency
and intermittent periods of inability to perform occupational
tasks (although generally functionally satisfactory with
routine behavior, self-care and conversation normal), due to
symptoms such as depressed mood, anxiety, suspiciousness,
panic attacks (weekly or less often), chronic sleep
impairment, mild memory loss (such as forgetting names,
directions, recent events). 38 C.F.R. § 4.130, Diagnostic
Code 9411.
On VA examination in 1995, it was noted that the veteran did
not meet the criteria for PTSD. Since 1995 the veteran has
been seen by Dr. Morrow, at times at lengthy intervals, for
treatment of psychiatric symptoms. Treatment records from
this doctor primarily concern non-service-connected
psychiatric problems, such as bipolar disorder, although at
times since 1997 PTSD has also been noted. On VA examination
in 1998, the veteran reported PTSD symptoms; he indicated he
was getting ready to retire from his job as a federal
marshal; mild PTSD was diagnosed; and the GAF score was 70.
Shortly after such examination, the veteran retired from his
job.
In a 1998 statement, Dr. Morrow said that the veteran retired
early due to chronic PTSD symptoms. However, a review of all
the evidence indicates that the veteran took a planned normal
retirement from federal service based on longevity of
service, and there is no probative evidence that he retired
on disability or that PTSD prompted early retirement. Since
retiring from work, the veteran has done what normal people
do in retirement, engaging in leisure activities and
otherwise enjoying the fruit of many years of labor. The
2000 VA examination notes the veteran was retired and had an
active social life and participated in a wide range of
activities. The examiner noted the veteran's social
adaptability and interactions with others did not appear to
be impaired, PTSD-related symptoms produced only very mild
occupational impairment, and the GAF score was 70. In a
subsequent letter in 2000, Dr. Morrow said the veteran's GAF
score was 65.
A GAF score is not binding as to the percentage rating to be
assigned for a psychiatric condition. Nevertheless, the
reported GAF scores ranging from 65 to 70 signify, under DSM-
IV, only some mild symptoms or that the person has some
occupational difficulty but is generally functioning pretty
well. This is compatible with no more than the 10 percent
rating currently assigned for PTSD.
The evidence in its entirety demonstrates virtually no social
impairment and at most mild occupational impairment from
PTSD. PTSD has been well controlled with regular medication.
These factors support no more than the current 10 percent
rating for PTSD under the criteria of Code 9411. The extent
of PTSD symptoms and the associated occupational and social
impairment, as described in the code for a 30 percent rating,
are not demonstrated. The Board finds that the veteran's
impairment due to PTSD more nearly approximates the criteria
for a 10 percent evaluation than a 30 percent rating, and
thus the lower 10 percent rating is to be assigned.
38 C.F.R. § 4.7. This is an initial rating case, but at no
time since the effective date of service connection for PTSD
has the condition been more than 10 percent disabling.
Fenderson v. West, 12 Vet.App. 119 (1999) ("staged ratings"
to be considered in initial rating cases).
The preponderance of the evidence is against a rating higher
than 10 percent for PTSD. Thus, the benefit-of-the-doubt
rule does not apply, and the claim for a higher rating must
be denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1
Vet. App. 49 (1990).
ORDER
A rating higher than 10 percent for PTSD is denied.
L.W. TOBIN
Veterans Law Judge
Board of Veterans' Appeals